Eliciting preference for private health services among patients in Iran: evidence from a discrete choice experiment

Purpose The provision of private health-care services by public hospitals is common in Iran. Examining factors associated with patients’ preferences to use private health services and using this knowledge in health planning and policymaking can help expand the use of such services. Thus, this study aims to investigate patients’ preferences for private health services delivered in public hospitals. Design/methodology/approach Based on a discrete choice experiment from a sample of 375 patients in a public training hospital in Qazvin, northwest city of Iran, the authors evaluated participants’ preference over the health-care attributes affecting their choice to use private health-care services delivered in the hospital. The authors also estimated the marginal willingness to pay to determine the maximum amount a patient was willing to pay for the improvement in the level of each health-care attributes. Findings The findings revealed that patients were 2.7 times more likely to choose private hospital services when the waiting time was reduced to less than a week. Furthermore, as patients had complimentary insurance coverage, they were over 60% more likely to receive such services from training hospitals. Finally, continuity of care and reduced health-care tariffs were significant factors that increased patients’ preference to choose private services by 52 and 37%, respectively. Originality/value Examining factors associated with patients’ preferences to use private health services and using this knowledge in policymaking can help expand such services. The findings affirmed that various incentives, including service quality factors, are required to increase the likelihood of patients choosing private services.

Eye Camp Surgery

Cataract surgery is the most frequently performed operative procedure in the human body.1 In Pakistan, we have very meagre trained Human Resources and equipment.2 At onetime, eye-camp surgery was promoted by the government to tackle the growing burden of cataract-related blindness. As time passed on, we developed public and private health care delivery services. Now we have ample resources to deal with an ever-growing number of cataracts. In the current scenario, eye camp surgery is not justified. But it seems as if government and regulatory bodies have no intentions to focus on this point.

Study of Health Care Practices and Comorbidities in Diabetic Population at Small Community Level in Biratnagar: A Cross-Sectional Descriptive Study

Background: Death in diabetes mellitus occurs mostly due to co-morbidities and complications resulting from diabetes. To reduce morbidity and mortality, awareness regarding diabetes and its complications is necessary. The aim of the study is to assess the health care practices and co-morbidities associated with the disease. Materials and Methods: A descriptive cross-sectional study was conducted at community level (Kharji ward number 4) at Biratnagar. All diagnosed patients of type II diabetes mellitus ≥ 18 years of age were enrolled for the study. Data for socio-demographic factors and clinical status were collected by pretested semi structured Questionnaire. Random blood sugar was measured using a portable glucometer. Anthropometric measurements were done by measuring height and weight of participants and body mass index was calculated by standard formula. The data was analyzed using SPSS version 21.0. Results: Out of the total 205 participants, 55.7% were found to be within the age group of 45-64 years i.e. middle aged (55.6%). Almost equal participants of the male and female were found, 50.7% and 49.3% respectively. More participants were found of below poverty line 67.31%. More than half 47.8% of the participants were suffering from the diabetes for less than 5 years of duration. All most all participants 98.5% knew about diabetes and its complications. Majority of the respondents 62.4% were having co-morbidity, among them 34.6% of participants were having hypertension. Majority of the participants were utilizing private health care service 79%. Conclusion: The diabetic participants were mostly of middle age with almost equal number of male and female having adequate knowledge about diabetes. Hypertension was the most common co morbidity among participants and they preferred private health care service mostly.

Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients

<b><i>Introduction:</i></b> Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors. <b><i>Methods:</i></b> This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time &#x3e;1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of <i>p</i> ≤ 0.05 was taken as significant. <b><i>Results:</i></b> The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course &#x3e;2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (<i>p</i> = 0.00001). <b><i>Conclusions:</i></b> We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.

Engaging Private Health Care Providers to Identify Individuals with TB in Nepal

In Nepal, 47% of individuals who fell ill with TB were not reported to the National TB Program in 2018. Approximately 60% of persons with TB initially seek care in the private sector. From November 2018 to January 2020, we implemented an active case finding intervention in the Parsa and Dhanusha districts targeting private provider facilities. To evaluate the impact of the intervention, we reported on crude intervention results. We further compared case notification during the implementation to baseline and control population (Bara and Siraha) notifications. We screened 203,332 individuals; 11,266 (5.5%) were identified as presumptive for TB and 8077 (71.7%) were tested for TB. Approximately 8% had a TB diagnosis, of whom 383 (56.2%) were bacteriologically confirmed (Bac+). In total, 653 (95.7%) individuals were initiated on treatment at DOTS facilities. For the intervention districts, there was a 17%increase for bacteriologically positive TB and 10% for all forms TB compared to baseline. In comparison, the change in notifications in the control population were 4% for bacteriologically positive, and −2% all forms. Through engagement of private sector facilities, our intervention was able to increase the number of individuals identified with TB by over 10% in the Parsa and Dhanusha districts.

Health Care Fictions: The Business of Medicine and Modern US Literature

The literary and cultural dimensions of the longstanding US political debate over public versus private health care have been critically underexplored. How did early twentieth-century US writers portray the business of medical care within a stratified US economy? In Robert Herrick’s The Healer (1911), Wallace Thurman and A. L. Furman’s The Interne (1932), and Frank G. Slaughter’s That None Should Die (1941), the problems of inequality, profit, and corruption plague the practice of professional medicine. The writers of these novels do not, for the most part, blame the trouble with care on individual nurses, doctors, or other medical staff. Instead of exposing the power of individual medical practitioners to exploit bodies, these novels call attention to the power of capitalism and inequality to distort and derange the mission of medicine. Yet, the political critiques offered by health care fictions are foreclosed by anxieties about collective reform and government intervention in health care. So, this article asks why some of the most sustained literary treatments of capitalist medicine in US literature ultimately retreat from the structural critiques that they themselves raise.